广州市孕妇孕期日夜复合热暴露与早产的关联及机制  

Association of maternal exposure to compound hot extreme during pregnancy with preterm birth and the potential biological mechanisms in Guangzhou

作　　者：周鹤 李致兴 陈桂敏 刘欣 董墨染 王嘉琪 陈邓周 肖建鹏[1] 何冠豪 胡建雄 容祖华 马文军[1,3] 刘涛 ZHOU He;LI Zhixing;CHENGuimin;LIU Xin;DONG Moran;WANG Jiaqi;CHEN Dengzhou;XIAO Jianpeng;HE Guanhao;HU Jianxiong;RONG Zuhua;MA Wenjun;LIU Tao(Guangdong Provincial Institute of Public Health,Guangdong Provincial Center for Disease Control and Prevention,Guangzhou,Guangdong 511430,China;School of Public Health,Guangdong Pharmaceutical University,Guangzhou,Guangdong 510310,China;School of Medicine,Jinan University,Guangzhou,Guangdong 510632,China;School of Public Health,Southern Medical University,Guangzhou,Guangdong 510515,China)

机构地区：[1]广东省疾病预防控制中心广东省公共卫生研究院,广东广州511430 [2]广东药科大学公共卫生学院,广东广州510310 [3]暨南大学基础医学与公共卫生学院,广东广州510632 [4]南方医科大学公共卫生学院,广东广州510515

出　　处：《环境与职业医学》2022年第3期289-295,303,共8页Journal of Environmental and Occupational Medicine

基　　金：国家重点研发计划项目(2018YFA0606200);国家自然科学基金项目(81874276);广东省自然科学基金项目(2019A1515011264);广州市科技计划项目(202102080565)

摘　　要：[背景]全球变暖可能会增加日夜复合热的频率,但目前尚缺乏日夜复合热与早产关系的研究,且生物学机制也不明了。[目的]分析孕妇孕期日夜复合热暴露对早产的影响,并探讨炎性反应、氧化应激和内皮功能改变在日夜复合热与早产关系中的作用。[方法]所有研究孕妇来自前期在广州开展的产前环境与后代健康前瞻性出生队列。本次研究选取在2014—2017年暖季(5—10月)分娩的2449名产妇为研究对象,其中311名早产(n=43)和足月产(n=268)孕妇在分娩时提供了血样。日热和夜热定义为日最高温/日最低温分别高于研究期间日最高温/日最低温排序的第90百分位数,日夜复合热定义为一个炎热的夜晚伴随一个炎热的白天。气象数据来源于中国气象科学数据共享服务平台,并利用Anusplin空间插值方法获得所有孕妇居住地的日最高温、日最低温和相对湿度。利用酶联免疫分析法检测孕妇血清中C反应蛋白(CRP)、内皮素-1(ET-1)和丙二醛(MDA)3种生物标志物的水平,并进行对数转换。采用分布滞后非线性模型分析不同滞后天数内日热、夜热和日夜复合热引起早产的平均效应,并采用logistic回归模型分析3种生物标志物与早产的关系。[结果]研究对象中早产的发生率为6.2%。与非高温天气相比,日夜复合热在滞后3、7和14 d引起早产的平均RR(95%CI)分别为1.43(1.12~1.84)、1.24(1.08~1.43)和1.17(1.05~1.30),并且日夜复合热在滞后14 d时与孕妇血清中CRP、ET-1和MDA水平呈正相关,累积效应(%difference)(95%CI)分别为0.33%(–0.45%~1.12%)、0.59%(0.11%~1.07%)和0.57%(0.09%~1.05%),后两者具有统计学意义。与孕妇血清中CRP、ET-1和MDA浓度的最低四分位数Q1组相比,最高四分位数Q4组发生早产的RR(95%CI)分别为1.27(0.5~3.22)、1.51(0.61~3.72)和2.07(0.81~5.27),但上述改变均无统计学意义。[结论]孕妇孕期暴露于日夜复合热可能增加早产的风险,�[Background]Global warming may increase the frequency of compound hot extreme(CHE).However,there is still a lack of studies assessing the associations between CHE and preterm birth(PTB),and the underlying biological mechanisms remain unclear.[Objective]To estimate the association of exposure to CHE during pregnancy with PTB,and to explore the roles of inflammatory,endothelial dysfunction,and oxidative stress in the association between CHE and PTB.[Methods]All participants were selected from the Prenatal Environments and Offspring Health(PEOH),a prospective birth cohort conducted in Guangzhou.In this study,a total of 2449 participants who gave birth from May to October in 2014 to 2017 were enrolled,and among them blood samples were collected from 311 preterm(n=43)and full-term(n=268)pregnant women at the time of delivery.A hot day/night was identified as a day when the daily maximum temperature/minimum temperature was higher than its 90th percentile in the study period,and a CHE was defined as having both a hot night and a following hot day.The meteorological data were obtained from the China Meteorological Data Sharing Service System.Anusplin was used to assess the daily maximum temperature,daily minimum temperature,and relative humidity of the participant residence.Enzyme-linked immunosorbent assay(ELISA)was used to measure C reactive protein(CRP),endothelin-1(ET-1),and malondialdehyde(MDA)levels in maternal serum,and their results were transformed by natural logarithm.A distributed lag nonlinear model was used to investigate the associations of exposures to hot day,hot night,and CHE during pregnancy with PTB at different lag days,and a logistic regression model was used to investigate the associations of CRP,ET-1,and MDA with PTB.[Results]The incidence rate of PTB was 6.2%in all selected participants.Compared with the non-hot day,the RRs(95%CIs)of CHE in lag3,7,and 14 days on PTB were 1.43(1.12-1.84),1.24(1.08-1.43),and 1.17(1.05-1.30),respectively,and the cumulative effects(%difference)(95%CI)of CHE in lag 14

关 键 词：日夜复合热 早产 生物学机制 出生队列研究 

分 类 号：R714.21[医药卫生—妇产科学] R122.2[医药卫生—临床医学]